Health Service Information

Blood pressure (low)

Low blood pressure, also sometimes referred to as hypotension, is a condition where the arterial blood pressure is abnormally low. Blood pressure is a measure of the force that your heart uses to pump blood around your body. Usually, the lower your blood pressure, the healthier you are.

The heart

The heart is a muscle that is designed to pump a constant supply of blood around the body. When your heart beats, it pushes the blood around your body through tubes called arteries and capillaries. When your heart rests in between beats, the blood flows back to your heart through a network of veins.

Blood pressure

Blood pressure is a measure of the force of the blood on the walls of the arteries as the blood flows through them. It is measured in millimetres of mercury (mmHg).

When your blood pressure is measured, two measurements are recorded during a single heartbeat. The two measurements are known as the systolic pressure and the diastolic pressure.

Systolic pressure is the pressure when your heart beats and squeezes blood into your arteries. At this stage, the pressure in your arteries is at its highest.

Diastolic pressure is the pressure when your heart rests in between beats and the blood flows back to your heart through your veins. At this stage, the pressure in your arteries is at its lowest.

Your blood pressure reading will be given as two numbers, with your systolic reading first, followed by your diastolic reading. If your systolic blood pressure is 120 mmHg, and your diastolic blood pressure is 80 mmHg, your blood pressure is 120 over 80, which is commonly written as 120/80.

The highs and lows

As a general guide, the ideal blood pressure for a young, healthy adult is 120/80 or less. If you have a reading of 140/90, or more, you have high blood pressure (hypertension). This puts you at greater risk of serious health conditions, such as strokes or heart attacks.

Low blood pressure is also known as hypotension. People with a reading of around 90/60 or less are commonly regarded as having low blood pressure. If you have low blood pressure, you do have some protection against factors that increase blood pressure, such as eating too much salt, not eating enough fruit and vegetables or being overweight. You also have some protection against the diseases caused by high blood pressure.

Some people who have low blood pressure experience symptoms as a result of it. There may be an underlying cause that could need treatment.

Arteries

Arteries are blood vessels that carry blood from the heart to the rest of the body.

High blood pressure

High blood pressure is the same as hypertension, when the pressure of the blood in your bloodstream is regularly above 140/90 mmHG.

Hypertension

Hypertension is the same as high blood pressure, when the pressure of the blood in your bloodstream is regularly above 140/90 mmHG.

Veins

Veins are blood vessels that carry blood from the rest of the body back to the heart.

If you experience the symptoms of hypotension after changing positions, for example, standing up, it is known as postural, or orthostatic, hypotension. If you experience these symptoms after eating, it is known as postprandial hypotension.

Postural or orthostatic hypotension

Postural or orthostatic hypotension occurs when your blood pressure falls after a sudden movement. For example, you may feel dizzy or faint after changing posture, such as sitting up from a lying position or standing up from a sitting position. This may cause you to lose your balance and fall over. You may also feel light-headed, have blurred vision, or lose consciousness.

The symptoms of postural or orthostatic hypotension should only last a few minutes as your blood pressure adjusts to your new position. This type of low blood pressure tends to affect people more as they get older when it can lead to more frequent falls. Similar symptoms may also occur after exercise.

Postprandial hypotension

Your blood pressure can sometimes decrease (fall) after eating, causing dizziness, light-headedness, fainting and falls. This condition, known as postprandial hypotension, tends to occur more often in older people, particularly in those who have:

high blood pressure

a condition such as Parkinson's disease

diabetes

After a meal, your intestines need a large amount of blood for digestion. Your heart rate increases and the blood vessels in other parts of your body constrict (narrow) to help maintain blood pressure. If your heart rate does not increase enough, or if your blood vessels do not constrict enough to maintain blood pressure, your blood pressure will fall. You can then start experiencing symptoms.

Blood

Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.

Blood vessels

Blood vessels are the tubes in which blood travels to and from parts of the body. The three main types of blood vessels are veins, arteries and capillaries.

Brain

The brain controls thought, memory and emotion. It sends messages to the body controlling movement, speech and senses.

Heart

The heart is a muscular organ that pumps blood around the body.

High blood pressure

Hypertension is when the pressure of the blood in your bloodstream is regularly above 140/90 mmHG.

Nausea

Nausea is when you feel like you are going to be sick.

Palpitations

Palpitations refer to an irregular heartbeat, or the sensation of skipped or extra heartbeats.

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Throughout the day, your blood pressure can vary by between 30-40 mmHg (both systolic and diastolic) depending on what you are doing. Having a stressful week at work, the temperature outside and even what you had for lunch could affect your blood pressure reading.

Each time that you have your blood pressure measured, it is important that the test is carried out under similar conditions to ensure that the results are consistent. If you have a low blood pressure reading, your GP will first consider the everyday causes that might have affected it, before considering the possible underlying causes.

Everyday causes

Many factors have a daily, or even hourly, effect on your heart and circulation. Below are things that could affect your blood pressure and, in some cases, may cause low blood pressure.

The time of day - your blood pressure falls overnight so it will be low in the morning.

Your age - typically, blood pressure rises as you get older, although postural, or orthostatic, and postprandial hypotension are also more likely in the elderly.

How stressed or relaxed you are - if you are stressed, your heart will beat faster and your blood pressure will increase, and the opposite if you are relaxed.

How much exercise you do - initially, exercise will raise your blood pressure, but if you are healthy and exercise regularly, your blood pressure will be low when you are resting.

Your temperature - if you are cold, your heartbeat will slow down and your blood pressure will fall.

If you have recently eaten - blood will be used for digesting food in your stomach, so the blood pressure elsewhere in your body will fall.

Underlying causes

If your blood pressure is still considered low after taking into account everyday factors, such as those listed above, there may be another cause. Some possibilities are explained below.

Medication

Some medication may cause hypotension as a side effect. This tends to be orthostatic or postural hypotension (low blood pressure when you stand up, or change position). Examples of medication that can cause hypotension include:

alpha-blockers - a medicine that is prescribed to lower blood pressure for people with hypertension (high blood pressure)

some antidepressants.

Your GP will discuss any possible side effects with you when prescribing medication. While you are taking medication, your blood pressure will be carefully monitored if you are considered to be at risk of hypotension.

Serious illnesses or conditions

If you have an acute (short-term) illness, your blood pressure will be measured regularly because it is a good indicator of the severity of your illness. A heart condition, such as heart disease or a heart attack, can also cause low blood pressure, as your heart may not be able to pump blood around your body.

Autonomic disorders

Autonomic disorders affect your autonomic nervous system and can cause hypotension. Your autonomic nervous system is part of your nervous system (the network of cells that carry information around your body). It controls the bodily functions that you do not actively think about, such as sweating, digestion and the beating of your heart.

The autonomic nervous system also controls the widening and narrowing of your blood vessels. If there is a problem with it, your blood vessels could remain too wide, causing low blood pressure. In particular, autonomic disorders tend to cause orthostatic hypotension.

Some examples of autonomic disorders are:

diabetes mellitus - a long-term (chronic) condition caused by too much glucose (sugar) in the blood

Parkinson's disease - a chronic condition that affects the way the brain coordinates body movements

multiple system atrophy - a disorder that causes the brain signals to the muscles and limbs responsible for movement to deteriorate.

Adrenal glands

The adrenal glands are two small glands that are located just above your kidneys. They produce hormones that control your blood pressure and maintain the balance of salt and water in your body. One of the hormones they produce is aldosterone, which is responsible for controlling the amount of salt in your body.

If your adrenal glands become damaged - for example through an infection or a tumour - the production of aldosterone may be reduced, resulting in a loss of salt from your body. This can cause dehydration which, in turn, leads to low blood pressure.

If a problem with your adrenal glands is diagnosed, it can be treated by increasing the amount of aldosterone in your body. This could also be a symptom of Addison's disease (a condition in which the adrenal glands cannot produce enough of the hormones cortisol and aldosterone). Addison's disease can also be treated with medication.

Serious injuries and shock

Low blood pressure can also be caused by serious injuries or burns, particularly if you have lost a lot of blood. This can mean that there is less blood being pumped around your body. Low blood pressure can also occur if you go into shock after having a serious injury.

Other kinds of shock are described below.

Septic shock and toxic shock syndrome

Septic shock and toxic shock syndrome are caused by bacterial infections. The bacteria attack the walls of the small blood vessels, causing them to leak fluid from the blood into the surrounding tissues. This causes a significant drop in blood pressure (severe hypotension).

Anaphylactic shock

Anaphylactic shock, or anaphylaxis, is caused by an allergic reaction to something such as a wasp sting or a peanut. During an allergic reaction, your body produces a large amount of a chemical called histamine, which causes your blood vessels to widen and leading to a sudden, severe drop in blood pressure.

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Measuring blood pressure

A blood pressure reading is taken using two measurements. The first is known as systolic, which is the pressure in your arteries when your heart contracts and pushes the blood around your body. The second measurement is known as diastolic, which is the pressure in your arteries when your heart refills with blood in between heart beats. Both systolic and diastolic blood pressures are measured in millimetres of mercury (mmHg).

Sphygmomanometer

Your GP or practice nurse will use a device known as a sphygmomanometer to measure your blood pressure. This device has an inflatable cuff and a scale of mercury, like a thermometer, as a pressure gauge. The cuff is placed around your upper arm and inflated to restrict the flow of blood in your arm. The air is then slowly released from the cuff.

Your GP, or practice nurse, will watch the mercury pressure gauge and listen to your blood flow in the main artery of your arm using a stethoscope. Upon hearing your heart beat, the systolic pressure will be recorded. When the sound disappears, the diastolic pressure will be recorded.

After you have had your blood pressure taken, your GP or nurse will give you your systolic reading first followed by your diastolic reading. If your systolic blood pressure is 120 mmHg, and your diastolic blood pressure is 80 mmHg, you will be told that your blood pressure is 120 over 80, written as 120/80.

What is low blood pressure?

As a general guide, low blood pressure is a reading of 90/60. However, it is not necessary for both your systolic and diastolic readings to be in this range for it to be considered low blood pressure. For example, a reading of 80/65 would be considered low because the systolic number is in the low range, and 100/55 would also be considered as low because the diastolic number is in the low range.

If you have low blood pressure according to this guide, you do not need to worry. Having low blood pressure is considered healthy as it protects you from the risks and diseases of high blood pressure. You will only need to have treatment if you are experiencing symptoms as a result of your low blood pressure.

Mean arterial blood pressure

As well as measuring your blood pressure, your GP or practice nurse may also calculate your mean arterial pressure (MAP). This is the average pressure required to push blood through your body. The reading takes account of blood flowing away from your heart and to it, and it can be a better indication of whether your blood pressure is too low.

Your MAP can be calculated from your normal blood pressure reading using the following formula:

If your MAP is below 65 mmHg, it is possible that your brain and vital organs aren't receiving enough oxygen. According to this calculation, a low blood pressure reading of 90/60 gives an MAP of 70 mmHg. This is still unlikely to cause health problems.

Postural or orthostatic hypotension

If your symptoms of low blood pressure mostly occur when you change position (postural or orthostatic hypotension), then your blood pressure may be measured before and after you move. For example, your blood pressure may be measured while you are sitting down and again while you are standing up.

Depending on what your seated blood pressure was, if your systolic reading drops by between 15-30 mmHg when you stand up, you may have orthostatic hypotension.

Underlying causes

Your GP or practice nurse will usually be able to diagnose low blood pressure very easily. However, determining the reason for low blood pressure can be more difficult.

If you have an underlying condition that is causing low blood pressure, it is likely that you will have other symptoms as well. Discuss these with your GP, who may recommend that you have further tests.

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If you have low blood pressure (hypotension) but you do not have any symptoms, you do not require treatment. If you are experiencing symptoms, your GP will try to establish the underlying cause of your hypotension in order to determine what treatment is necessary.

Medication

If you are taking medication, and your GP suspects that it may be causing low blood pressure, they will probably recommend a change of medication, or alter your dose. This includes medication to treat high blood pressure (hypertension), and medication to treat Parkinson's disease.

Your blood pressure will be monitored while you are taking medication, and any changes will be noted by your GP or practice nurse. If you are experiencing side effects from taking medication, tell your GP.

Underlying illnesses or conditions

If your GP suspects that a disorder such as a heart condition, adrenal gland failure or a nerve condition is causing your low blood pressure, you may be referred to hospital for further tests and treatment.

If adrenal gland failure is found to be causing your low blood pressure, your GP may prescribe fludrocortisone to replace the missing hormone, aldosterone. This will usually be in tablet form and will need to be taken for life.

If a nerve condition is causing your low blood pressure, it can be more difficult to treat. You may be prescribed medication in order to help stimulate your nervous system.

Fluids and salt

Dehydration- when the water and salt content of your body is reduced - can cause low blood pressure. This can be easily treated by increasing your fluid and salt intake. Ensuring that you drink enough fluid (at least eight glasses a day) will help with hypotension. This is because more fluids will increase the volume of your blood, and having more blood in your arteries will increase your blood pressure.

While people who have high blood pressure are usually advised to restrict their salt intake, if you have low blood pressure you may be advised to include more salt in your diet. Your GP will be able to advise you about how much additional salt you need and whether you can add salt to your usual food, or if you need to take salt tablets.

General advice

The following tips will help to limit your symptoms of hypotension, particularly postural or orthostatic hypotension:

Stand up gradually, particularly first thing in the morning. It may also be useful to try some other physical movements first to increase your heart rate and the flow of blood around your body. For example, stretching in bed before you get up, or crossing and uncrossing your legs if you are seated and about to stand.

Wear support stockings, sometimes called compression stockings. These are tight-fitting elastic socks or tights. They provide extra pressure to your feet, legs, and abdomen, which will help stimulate your circulation and increase your blood pressure.

Raise the head of your bed, or use extra pillows under your head. This will increase the flow of blood in your body and will also make it easier when you need to get up.

Avoid caffeine at night, and limit your alcohol intake - this will help you to avoid dehydration, which can cause low blood pressure.

Eat small frequent meals, rather than large ones - this will help you to prevent postprandial hypotension (low blood pressure after you have eaten). Lying down after eating, or sitting still for a while, may also help.

Very few people are prescribed medication for hypotension. The symptoms of hypotension can be usually be treated by making these small changes to your lifestyle and, in particular, by increasing your fluid and salt intake.

If medication is necessary, it will usually be medicines to expand the volume of your blood, or to constrict (narrow) your arteries. By increasing your blood, or decreasing your arteries, your blood pressure will increase, as there will be more blood flowing through a smaller space.

Arteries

Arteries are blood vessels that carry blood from the heart to the rest of the body.

Blood

Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.

Dehydrated

Dehydration is an excessive loss of fluids and minerals from the body.

Dose

Dose is a measured quantity of a medicine to be taken at any one time, such as a specified amount of medication.

Heart

The heart is a muscular organ that pumps blood around the body.

High blood pressure

Hypertension is when the pressure of the blood in your bloodstream is regularly above 140/90 mmHG.